IndividualActive
Ian Johnson, M.D.
NPI 1265404990 · Pediatric Adolescent Medicine Physician · Patrick Afb, FL
Provider details
- NPI number
- 1265404990
- Entity type
- Individual
- Primary specialty
- Pediatric Adolescent Medicine PhysicianAllopathic & Osteopathic Physicians
- Credential
- M.D.
- Sex
- Male
- Sole proprietor
- No
- License
- G0440 (TX)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Practice location
1381 South Patrick Dr, Patrick Afb
45 Medical Group
Patrick Afb, FL 32925-4162
Phone: (321) 494-8152
Fax: (321) 494-8533
Approximate (ZIP-level) locationGet directions
Mailing address
4066 Hield Rd Nw
Palm Bay, FL 32907-6307
Registry dates
- Enumerated
- 2006-02-06
- Last updated
- 2009-06-25
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.